Healthcare Provider Details

I. General information

NPI: 1013024777
Provider Name (Legal Business Name): LIFESCAPE MEDICAL ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 12/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8757 E BELL RD
SCOTTSDALE AZ
85260-1322
US

IV. Provider business mailing address

8757 E BELL RD
SCOTTSDALE AZ
85260-1322
US

V. Phone/Fax

Practice location:
  • Phone: 480-860-5500
  • Fax: 480-860-5511
Mailing address:
  • Phone: 480-860-5500
  • Fax: 480-860-5511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SUSAN S WILDER
Title or Position: OWNER
Credential: M.D
Phone: 480-860-5500